Anti Bacterial Efficacy of Terminalia Chebula, Terminalia Bellirica, Embilica Officinalis and Triphala on Salivary Streptococcus Mutans Count – A Linear Randomized Cross Over Trial

Introduction: From the oral health perspective, it is well established that microorganisms have an important role in caries aetiology.From the dawn of civilization, herbal plants have served an array of roles.Triphala a tradtional herbal Ayurvedic formula consists of three native fruits of india including Terminalia Chebula (T.chebula), Terminalia Bellirica (T.bellirica) and Embilica Officinalis (E.officinalis).As per Ayurvedic Formulary of India (AFI) Triphala is prepared by combining a 1:1:1 mixture of ground dry fruits called myrobalans.Till date, an inadequate number of clinical researches on herb based mouth rinses have been reported in Asia, especially in India and other Southeast Asian countries (where these products are most accepted and widely used).The present study was planned to assess the effectiveness of Triphala with its three constituents.Aim: The objective of this study was to determine the effect of Triphala, T. chebula, T. bellirica and E. officinalis aqueous extract rinses separately on Streptococcus mutans count at various time intervals. Materials and Methods:This is a double-blind, linear cross over, within group experimental trial conducted among subjects visiting the Department of Public Health Dentistry aged 15 to 40 years.In this design, subjects received all of the treatments sequentially in time.The independent variables to be assessed in this study were all the four interventions of herbal preparations used and the dependent variable assessed is anti bacterial efficacy.Each subject receives two or more different treatments.All the subjects were exposed to all four interventions: 1) T. chebula; 2) T. bellirica; 3) E. officinalis; and 4) Triphala and were provided 15 ml of the freshly prepared 10% rinse.The subjects were instructed not to eat or drink between salivary samples collection.Post rinse unstimulated salivary samples were collected at five minutes and 60 minutes intervals.All the salivary samples were transferred immediately to microbiological laboratory in sterile containers within one hour for microbiological analysis.Results: The mean Colony Forming Units (CFUs) of S. mutans with Triphala when compared to other three intervention was significantly reduced at 5 minutes and 60 minutes (p=0.001).E. officinalis showed least reduction of mean CFUs when compared to other three groups.Conclusion: It can be concluded that all four rinses were effective in reducing S. mutans CFUs, but 10% Triphala has greater efficacy than its other constituents.